Read Books Online and Download eBooks, EPub, PDF, Mobi, Kindle, Text Full Free.
Feasibility Of Monitoring Functional Capacity In Patients Undergoing Treatment For Head And Neck Cancer
Download Feasibility Of Monitoring Functional Capacity In Patients Undergoing Treatment For Head And Neck Cancer full books in PDF, epub, and Kindle. Read online Feasibility Of Monitoring Functional Capacity In Patients Undergoing Treatment For Head And Neck Cancer ebook anywhere anytime directly on your device. Fast Download speed and no annoying ads. We cannot guarantee that every ebooks is available!
Author :National Academies of Sciences, Engineering, and Medicine Publisher :National Academies Press ISBN 13 :0309489385 Total Pages :445 pages Book Rating :4.3/5 (94 download)
Book Synopsis Functional Assessment for Adults with Disabilities by : National Academies of Sciences, Engineering, and Medicine
Download or read book Functional Assessment for Adults with Disabilities written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2019-08-31 with total page 445 pages. Available in PDF, EPUB and Kindle. Book excerpt: The U.S. Social Security Administration (SSA) provides disability benefits through the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs. To receive SSDI or SSI disability benefits, an individual must meet the statutory definition of disability, which is "the inability to engage in any substantial gainful activity [SGA] by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." SSA uses a five-step sequential process to determine whether an adult applicant meets this definition. Functional Assessment for Adults with Disabilities examines ways to collect information about an individual's physical and mental (cognitive and noncognitive) functional abilities relevant to work requirements. This report discusses the types of information that support findings of limitations in functional abilities relevant to work requirements, and provides findings and conclusions regarding the collection of information and assessment of functional abilities relevant to work requirements.
Book Synopsis Clinical Care and Rehabilitation in Head and Neck Cancer by : Philip C. Doyle
Download or read book Clinical Care and Rehabilitation in Head and Neck Cancer written by Philip C. Doyle and published by Springer. This book was released on 2019-03-21 with total page 518 pages. Available in PDF, EPUB and Kindle. Book excerpt: Malignancies involving structures of the head and neck frequently impact the most fundamental aspects of human existence, namely, those functions related to voice and speech production, eating, and swallowing. Abnormalities in voice production, and in some instances its complete loss, are common following treatment for laryngeal (voice box) cancer. Similarly, speech, eating, and swallowing may be dramatically disrupted in those where oral structures (e.g., the tongue, jaw, hard palate, pharynx, etc.) are surgically ablated to eliminate the cancer. Consequently, the range and degree of deficits that may be experienced secondary to the treatment of head and neck cancer (HNCa) are often substantial. This need is further reinforced by the Centers for Disease Control and Prevention who have estimated that the number of individuals who will be newly diagnosed with HNCa will now double every 10 years. This estimate becomes even more critical given that an increasing number of those who are newly diagnosed will be younger and will experience the possibility of long-term survival post-treatment. Contemporary rehabilitation efforts for those treated for HNCa increasingly demand that clinicians actively consider and address multiple issues. Beyond the obvious concerns specific to any type of cancer (i.e., the desire for curative treatment), clinical efforts that address physical, psychological, communicative, and social consequences secondary to HNCa treatment are essential components of all effective rehabilitation programs. Comprehensive HNCa rehabilitation ultimately seeks to restore multiple areas of functioning in the context of the disabling effects of treatment. In this regard, rehabilitation often focuses on restoration of function while reducing the impact of residual treatment-related deficits on the individual’s overall functioning, well-being, quality of life (QOL), and ultimately, optimize survivorship. Regardless of the treatment method(s) pursued for HNCa (e.g., surgery, radiotherapy, chemoradiation, or combined methods), additional problems beyond those associated with voice, speech, eating and swallowing frequently exist. For example, post-treatment changes in areas such as breathing, maintaining nutrition, limitations in physical capacity because surgical reconstruction such as deficits in shoulder functioning, concerns specific to cosmetic alterations and associated disfigurement, and deficits in body image are common. Those treated for HNCa also may experience significant pain, depression, stigma and subsequent social isolation. Concerns of this type have led clinicians and researchers to describe HNCa as the most emotionally traumatic form of cancer. It is, therefore, essential that clinicians charged with the care and rehabilitation of those treated for HNCa actively seek to identify, acknowledge, and systematically address a range of physical, psychological, social, and communication problems. Efforts that systematically consider this range of post-treatment sequelae are seen as critical to any effort directed toward enhanced rehabilitation outcomes. Actively and purposefully addressing post-treatment challenges may increase the likelihood of both short- and long-term rehabilitation success in this challenging clinical population. Current information suggests that successful clinical outcomes for those with HNCa are more likely to be realized when highly structured, yet flexible interdisciplinary programs of care are pursued. Yet contemporary educational resources that focus not only on management of voice, speech, eating, and swallowing disorders, but also address issues such as shoulder dysfunction due to neck dissection, the significant potential for cosmetic alterations can offer a much broader perspective on rehabilitation. Contemporary surgical treatment frequently involves reconstruction with extensive procedures that require donor sites that include both soft tissue from a variety of locations (e.g., forearm, thigh, etc.), as well as bone (e.g., the scapula). Collectively, resources that address these issues and many other concerns and the resultant social implications of HNCa and its treatment can serve to establish a comprehensive framework for clinical care. Consequently, providing a highly specialized and comprehensive educational resource specific to HNCa rehabilitation is currently needed. The proposed edited book is designed to address this void in a single authoritative resource that is also accessible to the clinical readership. Integral to this proposed book is information that guides clinical approaches to HNCa rehabilitation, in addition to offering emphasis on the direct impact of changes in voice, speech, and swallowing and the impact of such losses on outcomes. Finally, while several other published sources currently exist (see attached list), the emphasis of these books is directed either toward the identification and diagnosis of malignant disease, clinical and surgical pathology, associated efforts directed toward biomedical aspects of cancer and its treatment, or those with a focus on a single clinical problem or approach to rehabilitation. Therefore, the content of the proposed multi-chapter text centers on delivering a systematically structured, comprehensive, and clinically-oriented presentation on a range of topics that will provide readers at a variety of levels with a strong, well-integrated, and empirically driven foundation to optimize the clinical care of those with HNCa. The primary audience for this textbook is undergraduate and graduate-level students in Speech-Language Pathology, as well as practitioners, especially hospital-based practitioners, in Speech-Language Pathology; other key audiences include junior and senior level otolaryngology residents and fellows, translational researchers in head and neck cancer, related medical specialists (e.g., radiation oncology), oncology nurses, and potentially other rehabilitation professionals such as occupational therapists, counseling psychologists, social workers, and rehabilitation counselors.
Book Synopsis Oncology Informatics by : Bradford W. Hesse
Download or read book Oncology Informatics written by Bradford W. Hesse and published by Academic Press. This book was released on 2016-03-17 with total page 449 pages. Available in PDF, EPUB and Kindle. Book excerpt: Oncology Informatics: Using Health Information Technology to Improve Processes and Outcomes in Cancer Care encapsulates National Cancer Institute-collected evidence into a format that is optimally useful for hospital planners, physicians, researcher, and informaticians alike as they collectively strive to accelerate progress against cancer using informatics tools. This book is a formational guide for turning clinical systems into engines of discovery as well as a translational guide for moving evidence into practice. It meets recommendations from the National Academies of Science to "reorient the research portfolio" toward providing greater "cognitive support for physicians, patients, and their caregivers" to "improve patient outcomes." Data from systems studies have suggested that oncology and primary care systems are prone to errors of omission, which can lead to fatal consequences downstream. By infusing the best science across disciplines, this book creates new environments of "Smart and Connected Health." Oncology Informatics is also a policy guide in an era of extensive reform in healthcare settings, including new incentives for healthcare providers to demonstrate "meaningful use" of these technologies to improve system safety, engage patients, ensure continuity of care, enable population health, and protect privacy. Oncology Informatics acknowledges this extraordinary turn of events and offers practical guidance for meeting meaningful use requirements in the service of improved cancer care. Anyone who wishes to take full advantage of the health information revolution in oncology to accelerate successes against cancer will find the information in this book valuable. Presents a pragmatic perspective for practitioners and allied health care professionals on how to implement Health I.T. solutions in a way that will minimize disruption while optimizing practice goals Proposes evidence-based guidelines for designers on how to create system interfaces that are easy to use, efficacious, and timesaving Offers insight for researchers into the ways in which informatics tools in oncology can be utilized to shorten the distance between discovery and practice
Book Synopsis Mobile Health Technologies by : Wilfred Bonney
Download or read book Mobile Health Technologies written by Wilfred Bonney and published by BoD – Books on Demand. This book was released on 2016-08-31 with total page 154 pages. Available in PDF, EPUB and Kindle. Book excerpt: Mobile Health Technologies, also known as mHealth technologies, have emerged, amongst healthcare providers, as the ultimate Technologies-of-Choice for the 21st century in delivering not only transformative change in healthcare delivery, but also critical health information to different communities of practice in integrated healthcare information systems. mHealth technologies nurture seamless platforms and pragmatic tools for managing pertinent health information across the continuum of different healthcare providers. mHealth technologies commonly utilize mobile medical devices, monitoring and wireless devices, and/or telemedicine in healthcare delivery and health research. Today, mHealth technologies provide opportunities to record and monitor conditions of patients with chronic diseases such as asthma, Chronic Obstructive Pulmonary Diseases (COPD) and diabetes mellitus. The intent of this book is to enlighten readers about the theories and applications of mHealth technologies in the healthcare domain.
Book Synopsis Cancer Care for the Whole Patient by : Institute of Medicine
Download or read book Cancer Care for the Whole Patient written by Institute of Medicine and published by National Academies Press. This book was released on 2008-03-19 with total page 455 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cancer care today often provides state-of-the-science biomedical treatment, but fails to address the psychological and social (psychosocial) problems associated with the illness. This failure can compromise the effectiveness of health care and thereby adversely affect the health of cancer patients. Psychological and social problems created or exacerbated by cancer-including depression and other emotional problems; lack of information or skills needed to manage the illness; lack of transportation or other resources; and disruptions in work, school, and family life-cause additional suffering, weaken adherence to prescribed treatments, and threaten patients' return to health. Today, it is not possible to deliver high-quality cancer care without using existing approaches, tools, and resources to address patients' psychosocial health needs. All patients with cancer and their families should expect and receive cancer care that ensures the provision of appropriate psychosocial health services. Cancer Care for the Whole Patient recommends actions that oncology providers, health policy makers, educators, health insurers, health planners, researchers and research sponsors, and consumer advocates should undertake to ensure that this standard is met.
Book Synopsis Handbook of Psychooncology by : Jimmie C. Holland
Download or read book Handbook of Psychooncology written by Jimmie C. Holland and published by Oxford University Press, USA. This book was released on 1989 with total page 808 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Telerehabilitation, E-Book by : Marcalee Alexander
Download or read book Telerehabilitation, E-Book written by Marcalee Alexander and published by Elsevier Health Sciences. This book was released on 2021-11-28 with total page 448 pages. Available in PDF, EPUB and Kindle. Book excerpt: Offering significant benefits to both healthcare providers and patients, telerehabilitation is a key component in the future of rehabilitation care. Telerehabilitation: Principles and Practice provides expert information from experienced practitioners in the field, covering the wide range of patients seen in a rehabilitation medical practice or a hospital-based system. It provides quick access to information on common rehabilitation diagnoses and practices and how you can best use telerehabilitation to provide timely, effective care to every patient. - Clearly explains the benefits and utility of telerehabilitation for improving access to care and outcomes for various patient populations. - Uses a reader-friendly format based on diagnosis of specific disorders and common problems. - Covers telerehabilitation for spinal cord injury, stroke, and cancer rehabilitation. - Discusses key topics such as telemedicine for persons with disabilities, telerehabilitation in developing countries, telerehabilitation for integrative health, and mechanisms of telerehabilitation. - Explains the nuances of starting a telerehabilitation practice and the associated legislative, revenue, and compliance issues. - Features numerous charts, graphs, illustrations, and photographs throughout. - Ideal for rehabilitation professionals, physiatrists, and PM&R residents and specialists, as well as physical and occupational therapists. - Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.
Author :National Academies of Sciences Engineering and Medicine Publisher : ISBN 13 :9780309683494 Total Pages : pages Book Rating :4.6/5 (834 download)
Book Synopsis Childhood Cancer and Functional Impacts Across the Care Continuum by : National Academies of Sciences Engineering and Medicine
Download or read book Childhood Cancer and Functional Impacts Across the Care Continuum written by National Academies of Sciences Engineering and Medicine and published by . This book was released on 2021-09-09 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Since the late 1960s, the survival rate in children and adolescents diagnosed with cancer has steadily improved, with a corresponding decline in the cancer-specific death rate. Although the improvements in survival are encouraging, they have come at the cost of acute, chronic, and late adverse effects precipitated by the toxicities associated with the individual or combined use of different types of treatment (e.g., surgery, radiation, chemotherapy). In some cases, the impairments resulting from cancer and its treatment are severe enough to qualify a child for U.S. Social Security Administration disability benefits. At the request of Social Security Administration, Childhood Cancer and Functional Impacts Across the Care Continuum provides current information and findings and conclusions regarding the diagnosis, treatment, and prognosis of selected childhood cancers, including different types of malignant solid tumors, and the effect of those cancers on childrenâ (TM)s health and functional capacity, including the relative levels of functional limitation typically associated with the cancers and their treatment. This report also provides a summary of selected treatments currently being studied in clinical trials and identifies any limitations on the availability of these treatments, such as whether treatments are available only in certain geographic areas.
Book Synopsis Cancer Rehabilitation by : Michael O'Dell, MD
Download or read book Cancer Rehabilitation written by Michael O'Dell, MD and published by Demos Medical Publishing. This book was released on 2009-04-22 with total page 1130 pages. Available in PDF, EPUB and Kindle. Book excerpt: A Doody's Core Title 2012 This new comprehensive reference provides a state-of-the-art overview of the principles of cancer care and best practices for restoring function and quality of life to cancer survivors. Authored by some of the world« leading cancer rehabilitation experts and oncology specialists, the principles section provides primer level discussions of the various cancer types and their assessment and management. The practice section thoroughly explores the identification, evaluation, and treatment of specific impairments and disabilities that result from cancer and the treatment of cancer.This groundbreaking volume enables the entire medical team to provide superior care that results in a better quality of life for cancer survivors. Features include: Multi-specialty editorship and authorship from physiatry, oncology, physical therapy, occupational therapy,and related disciplines. Focus on therapeutic management of cancer-related impairments and complications. In-depth treatment of the medical, neurologic, musculoskeletal, and general rehabilitation issues specific to this patient population.
Book Synopsis Head and Neck Cancer by : Elizabeth C. Ward
Download or read book Head and Neck Cancer written by Elizabeth C. Ward and published by Plural Publishing. This book was released on 2014-07-15 with total page 641 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Anesthesia for Otolaryngologic Surgery by : Basem Abdelmalak
Download or read book Anesthesia for Otolaryngologic Surgery written by Basem Abdelmalak and published by Cambridge University Press. This book was released on 2012-10-18 with total page 371 pages. Available in PDF, EPUB and Kindle. Book excerpt: Anesthesia for Otolaryngologic Surgery offers a comprehensive synopsis of the anesthetic management options for otolaryngologic and bronchoscopic procedures. Authored by world authorities in the fields of anesthesiology and otolaryngology, both theoretical concepts and practical issues are addressed in detail, providing literature-based evidence wherever available and offering expert clinical opinion where rigorous scientific evidence is lacking. A full chapter is dedicated to every common surgical ENT procedure, as well as less common procedures such as face transplantation. Clinical chapters are enriched with case descriptions, making the text applicable to everyday practice. Chapters are also enhanced by numerous illustrations and recommended anesthetic management plans, as well as hints and tips that draw on the authors' extensive experience. Comprehensively reviewing the whole field, Anesthesia for Otolaryngologic Surgery is an invaluable resource for every clinician involved in the care of ENT surgical patients, including anesthesiologists, otolaryngologists and pulmonologists.
Author :IARC Working Group on the Evaluation of Carcinogenic Risks to Humans Publisher :IARC ISBN 13 :9789283212850 Total Pages :354 pages Book Rating :4.2/5 (128 download)
Book Synopsis Betel-quid and Areca-nut Chewing and Some Areca-nut-derived Nitrosamines by : IARC Working Group on the Evaluation of Carcinogenic Risks to Humans
Download or read book Betel-quid and Areca-nut Chewing and Some Areca-nut-derived Nitrosamines written by IARC Working Group on the Evaluation of Carcinogenic Risks to Humans and published by IARC. This book was released on 2004 with total page 354 pages. Available in PDF, EPUB and Kindle. Book excerpt: A working group of sixteen experts from seven countries re-evaluated the evidence of the carcinogenicity of betel-quid and areca-nut chewing and some areca-nut related nitrosamines. Betel-quid and areca-nut chewing are widely practised in many parts of Asia and in Asian-migrant communities elsewhere in the world. There are hundreds of millions of users worldwide. They evaluated betel quid with tobacco as carcinogenic to humans (Group 1) on the basis of sufficient evidence of an increased risk of cancer of the oral cavity, pharynx and oesophagus. The working group reviewed epidemiological studies of human cancer, mainly studies from India, Pakistan and Taiwan (China). Studies on betel quid with tobacco and areca nut with tobacco in experimental animals now also provide sufficient evidence of carcinogenicity. The working group also evaluated betel quid without tobacco as carcinogenic to humans (Group 1), on the basis of sufficient evidence of an increased risk of oral cancer. Studies on betel quid without tobacco and areca nut without tobacco in experimental animals now also provide sufficient evidence of carcinogenicity. Areca nut, a common ingredient of betel quid and many different chewing preparations, including those available commercially, has been observed to cause oral submucous fibrosis
Book Synopsis Diagnosing and Treating Adult Cancers and Associated Impairments by : National Academies Of Sciences Engineeri
Download or read book Diagnosing and Treating Adult Cancers and Associated Impairments written by National Academies Of Sciences Engineeri and published by National Academies Press. This book was released on 2021-11-10 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Cancer is the second leading cause of death among adults in the United States after heart disease. However, improvements in cancer treatment and earlier detection are leading to growing numbers of cancer survivors. As the number of cancer survivors grows, there is increased interest in how cancer and its treatments may affect a person's ability to work, whether the person has maintained employment throughout the treatment or is returning to work at a previous, current, or new place of employment. Cancer-related impairments and resulting functional limitations may or may not lead to disability as defined by the U.S. Social Security Administration (SSA), however, adults surviving cancer who are unable to work because of cancer-related impairments and functional limitations may apply for disability benefits from SSA. At the request of SSA, Diagnosing and Treating Adult Cancers and Associated Impairments provides background information on breast cancer, lung cancer, and selected other cancers to assist SSA in its review of the listing of impairments for disability assessments. This report addresses several specific topics, including determining the latest standards of care as well as new technologies for understanding disease processes, treatment modalities, and the effect of cancer on a person's health and functioning, in order to inform SSA's evaluation of disability claims for adults with cancer.
Book Synopsis Management of Cancer in the Older Patient E-Book by : Arash Naeim
Download or read book Management of Cancer in the Older Patient E-Book written by Arash Naeim and published by Elsevier Health Sciences. This book was released on 2011-08-17 with total page 310 pages. Available in PDF, EPUB and Kindle. Book excerpt: Management of Cancer in the Older Patient, by Drs. Arash Naeim, David Reuben, and Patricia Ganz, offers the help you need to effectively diagnose, refer, and manage cancer in geriatric patients. You’ll see how to provide effective cancer screening; refer your patients to the right oncologist; deal with comorbidities, frailties, and other complications; navigate end-of-life issues; and much more. A templated, user-friendly format makes it easy to find and apply the answers you need. See how to best manage geriatric cancer patients with help from leading specialists in both geriatrics and oncology Make informed decisions as to when to refer patients to specialists. Provide the supportive care your patients and their families need on issues such as such as mental health, pain, fatigue, nausea, insomnia. Be prepared to help cancer survivors navigate their after-treatment care including adjuvant therapy, side effects, second cancers, quality of life, and other concerns. Offer accurate guidance on ethical issues like competency, end of life, hospice, the role of the caregiver, and more.
Book Synopsis Exercise Oncology by : Kathryn H. Schmitz
Download or read book Exercise Oncology written by Kathryn H. Schmitz and published by Springer Nature. This book was released on 2020-05-04 with total page 438 pages. Available in PDF, EPUB and Kindle. Book excerpt: This groundbreaking book presents a unique and practical approach to the evolving field of exercise oncology - the study of physical activity in the context of cancer prevention and control. Presenting the current state of the art, the book is sensibly divided into four thematic sections. Following an opening chapter presenting an overview and timeline of exercise oncology, the chapters comprising part I discuss primary cancer prevention, physical activity and survivorship, and the mechanisms by which these operate. Diagnosis and treatment considerations are discussed in part II, including prehabilitation, exercise during surgical recovery, infusion and radiation therapies, and treatment efficacy. Post-treatment and end-of-life care are covered in part III, including cardio-oncology, energetics and palliative care. Part IV presents behavioral, logistical and policy-making considerations, highlighting a multidisciplinary approach to exercise oncology as well as practical matters such as reimbursement and economics. Written and edited by experts in the field, Exercise Oncology will be a go-to practical resource for sports medicine clinicians, family and primary care physicians, oncologists, physical therapy and rehabilitation specialists, and all medical professionals who treat cancer patients.
Book Synopsis Cummings Otolaryngology E-Book by : Paul W. Flint
Download or read book Cummings Otolaryngology E-Book written by Paul W. Flint and published by Elsevier Health Sciences. This book was released on 2020-04-22 with total page 4393 pages. Available in PDF, EPUB and Kindle. Book excerpt: The most comprehensive, multi-disciplinary text in the field, Cummings Otolaryngology: Head and Neck Surgery, 7th Edition, provides detailed, practical answers and easily accessible clinical content on the complex issues that arise for otolaryngologists at all levels, across all subspecialties. This award-winning text is a one-stop reference for all stages of your career—from residency and board certification through the challenges faced in daily clinical practice. Updated content, new otology editor Dr. Howard W. Francis, and new chapters and videos ensure that this 7th Edition remains the definitive reference in today's otolaryngology. - Brings you up to date with the latest minimally invasive procedures, recent changes in rhinology, and new techniques and technologies that are shaping patient outcomes. - Contains 12 new chapters, including Chronic Rhinosinusitis, Facial Pain, Geriatric Otology, Middle Ear Endoscopic Surgery, Pediatric Speech Disorders, Pediatric Cochlear Implantation, Tongue-Ties and Lip Ties, Laryngotracheal Clefts, and more. - Covers recent advances and new approaches such as the Draf III procedure for CRS affecting the frontal recess, endoscopic vidian and posterior nasal neurectomy for non-allergic rhinitis, and endoscopic approaches for sinonasal and orbital tumors, both extra- and intraconal. - Provides access to 70 key indicator (Accreditation Council for Graduate Medical Education Key Indicator Procedures), and surgical videos – an increase of 43% over the previous edition. - Offers outstanding visual support with 4,000 high-quality images and hundreds of quick-reference tables and boxes. - Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.
Book Synopsis The Difficult Airway by : David B. Glick
Download or read book The Difficult Airway written by David B. Glick and published by Springer Science & Business Media. This book was released on 2012-12-05 with total page 308 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Difficult Airway provides a comprehensive textual and visual coverage of how to deal with patients who have expected or unexpected difficult airways. The text begins with a description of the incidence and importance of the difficult airway and then describes the ASA Difficult Airway Algorithm created to facilitate the management of “difficult airways.” The majority of the book features a comprehensive step-by-step approach to the rescue techniques listed as part of the ASA Algorithm. Noted experts in each of the techniques have been recruited by the book editors to present the information. Figures throughout the book illustrate important points and procedures. This is a wonderful resource for professionals in the health care field including anesthesiologists, intensive care physicians, emergency room physicians, nurses, and out-of-hospital first responders.
